Health Information – the Exciting Road Ahead!

Dr. Schreiber of San Augustine giving a typhoi...

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Hello everyone:

I have been privileged over the past couple of weeks to visit some of the most prestigious health care providers in the country and to hear their thoughts about the state of health information today.  I can tell you that we in the health information field are in for some exciting times ahead!  Whether we work for HIT or HIM companies or for health care providers, the changes occurring in health care mean that our roles in serving health care are changing too.  So there could be no better time to pick up our conversations again on Excellence in Health Information.

See the rest here…Health Information – the Exciting Road Ahead!

Til next time!

Change Ahead for M*Modal and MedQuist

Today’s world is full of change.  In the world of health care, with new discoveries, new treatments, and new technologies found seemingly every day, change may be the only constant.

And so it is with businesses that support health care, where change can lead to the need for migration to new service and product offerings and to corresponding changes in business models.  Consolidations of businesses in the health information service and technology domains often occur as companies seek to increase revenues, take advantage of synergies, or as in the case I’m going to talk about here, to merge two companies with different but complementary talents as part of a growth strategy.

Most of you have probably heard that my employer M*Modal is about to be affected by such a change.  On Monday, July 11,  a merger between M*Modal, a leader in speech recognition and natural language understanding technologies, and MedQuist, a leading provider of medical transcription services and documentation workflow technology, was announced.  It was also announced that Vern Davenport, former CEO of Misys Healthcare and long-time HIT industry leader, will become the CEO of the combined company.

This announcement came as a surprise to many who know us as the small but quickly growing company whose senior executives are the very guys you came to know as industry innovators.  It may not have been a surprise to some, however, who in view of market activity in recent years wondered at M*Modal’s ability to compete against significantly larger companies.

And though we at M*Modal have rather enjoyed being David in a David-and-Goliath-like competitive environment, our leaders understood that now is the time when acceleration of our efforts is needed for our customers.

MedQuist too has been observing changes in the industry and sees value in combining their world-class services with the industry-leading technology that will allow them to offer their customers the best of both worlds – innovative technology offered by people who understand the world in which it will be implemented and used.

What does this mean to M*Modal customers and to its partner relationships?  It means only good things.  To the partners who rely on M*Modal technology to provide services to their customers, it means robust strength.  To the partners who incorporate M*Modal solutions into their technology offerings, it means partnership with a company with greater market presence.  To our health care provider customers, it means greater flexibility and options.  And since M*Modal understands that our customers need us to act fast in response to health care’s changing needs, then perhaps most importantly, this merger means that M*Modal will have the ability to bring solutions to health care faster.

Many of you have been kind enough to ask what this means to me personally.  To be honest, I was surprised at the announcement, and was admittedly concerned.  I mean, anyone who knows me knows that I believe in M*Modal and its vision with my whole heart.  But… after a visit from our future leader, Vern Davenport, my concerns have changed to excitement, hope, and even eagerness.

In speaking with the M*Modal team, he made it clear that this is not a case of one company absorbing another.  To the contrary, he explained that we are two companies joining forces to support health care providers as they continue to adopt electronic health records and as they embark on the transformation to value-based care.   He told us that his role as the CEO of the newly formed company will not be a job for him – it will be a mission.  He said he is here for one reason – to make an impact on health care. Well, for me that was the statement that clinched it.  I’m in.

In short, this new relationship will ensure that M*Modal can continue on its path towards creating a collaborative ecosystem for health information that supports the health care provider and which contributes to health care itself.  We have always strived to serve those who serve the patient – and now we’ll have the ability to do so with even greater impact.

For the immediate future, the two companies will continue to operate separately as all the i’s are dotted and t’s are crossed.  But stay tuned for more!  I’ll be sure to keep you updated…

In the meantime, like me, rest assured that we are not the Starship Enterprise and the Borg (you know, “you will be assimilated. Resistance is futile.”)  Like Jean Luc Picard, current M*Modal CEO Michael Finke and the other M*Modal leaders will continue to lead us as we “boldly go where no one has gone before” into the exciting times ahead.  (CBS Entertainment, 2010)

For more details, here is a link to the formal announcement

All my best as always,


Still M*Modal

Disclaimer:  All nerdy Star Trek references are mine – not to be blamed on anyone else at MedQuist or M*Modal.

CBS Entertainment. (2010).  Star TrekTM. Retrieved July 14, 2011 from

Response to Questions…

Hello everyone:  Over the past couple of months I’ve been privileged to present at several conferences and to do a couple of webinars. Since then some questions about these presentations have been sent my way (thank you!).

I thought it might be helpful to provide some links to some past articles that might be of interest to anyone who has questions about some of the presentations.

Thanks so much for proving once again how dedicated the people in the health information industry are to providing and producing high-value health information!

As always, questions and comments are most welcome!



Speech Recognition – general

Is Speech Recognition the answer to all your problems?

Speech Rec is here to stay…

MT Compensation and Management

MT Compensation

The Demise of the Career MT

ACE 2010 Presentation – Keeping Transcription Relevant into the Future

What Factors Contribute to MT Career-Mindedness?

Slides from NEMA AHDI Presentation…

Optimization of speech recognition Technology Results

When Metrics Mean Nothing – The Myth of the “Percent Gain”

What does the Medical Transcription Industry Sell?

Narrative Documentation, Standards

Are we Telling the Real Health Story?

A Vision for Truly Meaningful Health Information

Speech Recognition as the Accelerator of Meaningful Clinical Documentation

Hello everyone: Over the last couple of weeks I had the opportunity to attend several conferences. One was the national conference of the Case Management Society of America (CMSA) (more about this visit later) which was held in San Antonio, Texas, (home of the Alamo). Then I had the privilege of presenting to two state HIMA conferences; New Jersey (NJHIMA) in Atlantic City, and then back to Texas (TxHIMA) for their state conference in Dallas.

As always, I really enjoyed meeting with state HIMA members. It is so satisfying to know that wherever you are in the country, HIM professionals have the same passion for safe, high-quality, useful health information. It is also interesting to see that everyone seems to be facing the same challenges with respect to adoption and use of electronic health records. Everywhere I go, I hear the same stories about point-and-click, template-driven EHR systems that are time-intensive and cumbersome for the physician, that don’t provide the necessary information for the HIM, and which cause concerns for the health care enterprise because of costs and questionable ROI.

Needless to say, there is always interest in discussing narrative documentation including how to produce it cost-effectively and efficiently, and how it can be used to generate the discrete data needed for the interoperable exchange of information, to provide data for reporting and analysis, to drive clinical decision support and other automated care protocols, and in general, to realize the benefits that we all expect as we make use of electronic health information.

Some of you have seen these before, but just in case, here are my slides:  NarrativeDocumentation_HIMA_20110629.

In a nutshell:

1. Today’s changing health care environment is setting higher standards for documentation while seemingly making it more difficult for physicians to document patient care. The need for documentation to support Meaningful Use, to drive the communications and reporting necessary for Accountable Care and the Patient-Centered Medical home, to enable the conversion to ICD-10 from ICD-9, and to support the reporting required to monitor quality and outcomes is increasing. It is more apparent than ever that comprehensive, complete, and accurate health information is integral to the functioning of any health care facility. And yet newer methods of documenting patient care are often inefficient and time consuming for the physician and are not intuitive for other consumers of health information.
2. Dictation is still a viable, economical, and effective means of capturing clinical information.
3. In order to be cost- and time-effective, options for clinical documentation must be made available based on the type of encounter being documented and the needs of the user. For some encounters, templated, structured forms are likely sufficient. For others, physicians may do very well with speech recognition and self-editing. For more complex encounters, physician dictation supported by skilled medical transcription might still be the best way to go. The point is – health care providers must have flexibility and options for capturing the complete, comprehensive level of information required to support patient care, coding for billing and reimbursement, research and population health reporting, and all of the other uses for health information.
4. Speech recognition and other technologies, when combined with efficient management practices, can be a cost-effective way to produce high-quality narrative documentation.
5. We cannot continue to look to the best practices that many services and providers have historically followed when implementing speech recognition. In the past the goal might have been to “create cheap documentation fast” – now the goal for clinical documentation MUST be, “create useful documentation efficiently.’
6. Quality is key. We are all hearing a great deal about natural language processing, computer assisted coding, and other technologies that will help us to process and make use of our health information – but if the documentation at the foundation of these technologies is poor – the technology can’t do its job.
7. Efficient management practices are another key component. The percentage of productivity gained does not necessarily reflect the increase in output! Again, technology is no replacement for effective management practices.
8. It is not, as many believe, necessary to eliminate narrative documentation in order to have semantically interoperable electronic information. The Health Story, HL7, IHE Consolidation project is making great strides towards the creation of interoperable standards for the exchange and use of health information which will allow us to have the structured and encoded clinical data that we need to support automated processes, while at the same time retaining the human-readable narrative information that is required for communication and understanding. I personally have always been a big believer in having my cake… and eating it too. 

If you have any questions about the slides or the presentation please let me know. I’d love to hear your thoughts and experiences!

Till next time,

AHDI – M*Modal Continuing Management for Modern Medical Transcription Series – Webinar

US medical groups' adoption of EHR (2005)

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Hello everyone:  It was my very great pleasure today to be the presenter for an AHDI webinar as part of the M*Modal – AHDI Management for Modern Medical Transcription series.

Today’s presentation was titled, “The Continuing Relevance of Medical Transcription in Health Care.”  Here is a pdf of the slides. AHDIWebinar_Transcription_Relevance_20110517

Key points:

Medical transcription:

  1. Is part of HIM.
  2. Can support Meaningful Use, ICD-10 coding, and computer assisted coding (CAC).
  3. Must provide documentation that is valuable and useful.
  4. Must emphasize quality of content over print format and cost.
  5. Supports options and flexibility for increased adoption.
  6. Can be cost-effective without sacrificing MT pay.

Back in the earlier days of speech recognition (and in fact many health care facilities and transcription companies  still follow these practices today), the best practices for speech recognition were much more limiting than they are now.  They tended to be directed at productivity – not towards the cost-effective creation of useful documentation.

Unfortunately, the emphasis on productivity and cost savings caused us to lose sight of what it is that we do – create high-quality, accurate, clinical documentation – and who creates it – the highly skilled, knowledgeable, Career-Minded, Medical Transcriptionist.

I myself stood up in front of a roomful of people at the 2006 AHIMA national conference and gave recommendations such as:

  • Select physicians carefully
  • Select MTs carefully. You will have plenty of volume left for traditional transcription.  Leave your high-producers in transcription and move your low- to mid-range producers to speech rec.
  • Have your MTs perform “as dictated” editing as much as possible.
  • Encourage physicians to adopt best practices for speech recognition.

That was before I came to M*Modal and realized that the right technology allows us to view documentation from a different perspective.  It allows us to get the real value and use out of clinical documents rather than only using them to check off a requirement on a chart completion list.  Luckily even the most stubborn of us can learn fast when we want to.  🙂

Today that list would look more like:

  • Bring on the doctors – let the technology sort out which result in quality sufficient for editing and which do not.
  • Train all of your MTs to edit.  Advanced speech recognition technology will cover a significant portion of the transcription volume.  Transcription IS editing.
  • Pay your highly-skilled, highly productive transcriptionists appropriately as they move into speech.  You cannot deliver the quality of documentation necessary to support requirements for meaningful use, ICD-10, or computer assisted coding, without them.
  • Create the requirements for documentation according to usefulness and quality.  “You get what you say” does not result in documentation that consistently adheres to content or quality needs.
  • The “average % productivity gained” is not the correct metric to use to measure the results of speech recognition; nor is it the correct means to determine a compensation plan.
  • Get your cost savings through a combination of effective use of the technology and workforce and performance management.  Understand that cost benefits come from increased output from fewer staff members – not a high average % increase.  Your increased output will allow you to take on more volume without increasing staff.  If your output increases enough that you can decrease staff, get rid of the “hobby MTs” and reward your Career-Minded MTs for making you more efficient.

Medical transcription must be about delivering high-quality, comprehensive, useful information – not cheap documentation – if it is to stay relevant as an enabler of health information technology.

All the best as always,



Preaching to the Choir at AHDI Florida

Sunrise at Fort Lauderdale Beach

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I must have been a very good girl lately, because here I am again visiting AHDI Florida whose annual meeting is, of course, right on the beautiful beach in Fort Lauderdale.  Pennsylvania has been a bit on the chilly and rainy side, so this feels pretty wonderful!

But my favorite thing about being here is the people of AHDI Florida. It must be all this sunshine, because they are so full of energy!  Their meeting this year is called, “The Winds of Change” and from my previous experiences with this group, they get that change is coming their way – and rather than bemoaning the fact – they are embracing it and making it their own.  In fact, they “get it” so well that in a way I feel like I’m cheating speaking here….I am, in effect, preaching to the choir.  🙂  But since I know the members of this group will take what they hear and will spread the gospel of dictation and transcription as enablers of electronic health information, then I can enjoy the Florida sunshine without guilt.

My presentation is titled Speech Recognition – Throw Away Everything you Thought you Knew.  In this presentation I will ask listeners to throw away a lot of common assumptions about speech recognition and transcription – including a few things I might have told them a few years ago before I joined M*Modal after some experiences with a different vendor.

Because you see – we did it wrong.  The message about speech recognition and transcription has always been about saving money, and that unfortunately has often meant decreasing MT line rates rather than looking at the many other ways the technology can be used to decrease costs. And now look where we are. We are in an era where comprehensive information is a must-have for quality and outcomes reporting, as a driver of automated clinical decision support systems, as a source of data for population health reporting, and as a foundation for technologies such as natural language processing and computer assisted coding.  But instead of promoting the fact that transcription is an excellent source of high-quality, comprehensive information which can adhere to all the content requirements a provider needs to drive other aspect of HIM and health care, we have been focused on productivity.

Many in the industry (not all!) have been focused on providing cheap documentation; not high-value documentation. They’ve been focused on print formats, not content requirements.  And worst of all, they’ve been driving down the value of our skilled medical transcriptionists causing them to leave the industry.  I actually had a service provider tell me during my trip to DC for the Advocacy Summit that hospitals aren’t reluctant to use offshore transcription anymore, not because they realized that the quality could be just as good, but because the types of errors that would have caused the cancellation of a contract ten years ago don’t even get mentioned today. In other words, it is about “cheap”; not about quality.  Folks, I’m here to tell you, the day a provider stops complaining about poor quality is the day they are telling you that you are extraneous, your documentation is not being used for anything important, and you are not long for this world.

As you all know – I don’t care if the transcription is done in the U.S., or in India, or on Mars. I don’t care if it’s being produced through traditional typing, backend speech, or telekinesis. Poor quality documentation is USELESS for all of the purposes that documentation must be used for today – from computer assisted coding to PQRS (formerly PQRI) reporting, to the use of the documentation as a communications tool for members of a patient care team in an ACO or patient-centered medical home, to the reconciliation of problem lists and creation of patient-facing summaries that is required as part of Meaningful Use, and more.  The quality MUST be there – or transcription won’t be.

Unfortunately many speech recognition vendors, and I’m sorry to say, even many transcription service organizations, continue to promote the wrong message – the message of “cheap” documentation, not valuable documentation.  Let me ask you this – if the health care provider is only giving up printed paper documents of inconsistent quality that are not being used for any purpose other than to check-off requirements on a chart completion list, when someone comes along and says, “hey, the docs can do direct-data entry into the EHR so we don’t need transcription anymore,” is the provider going to use, “but we get the transcription so cheap…” as a reason to convince the decision makers that transcription should be kept as a means of documentation?  Not hardly…

Let’s forget everything we thought we knew about speech recognition and transcription and look at it in a new light.  Let’s remember that dictation and transcription can be the accelerator of high-value electronic health information, not something that electronic information can replace.

So – all you folks out there in the choir – can I get an Amen?

All my best as always,

Transcription Quality Redux

QA Cycle

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Hello everyone: We’ve had a number of comments on the blog and through email about the post Quality Health Information – a Transcription Wake-up Call and it is certainly a topic that deserves attention.

I am hearing more in recent months about a practice that some companies use to decrease the amount of work sent to secondary QA levels before delivery to the provider. Companies select a threshold for how much work can be sent to QA – usually a percentage of total work transcribed or edited – and the MT is paid a lower line rate for work sent to QA that exceeds that threshold.  Balancing the push for productivity with quality is a difficult balancing act. Pushing an MT for  higher productivity (especially if line rates have already been decreased as speech recognition was introduced) does increase the temptation for an MT to send jobs to QA. How does an MT balance the need for speed with the amount of time she should spend researching a term?

I cannot comment on the specifics of this practice since I do not know what all of these companies do to support the MT otherwise, but I do have some questions.

  1. Does the MT have resources available to help complete the terms she isn’t able to make out or find through research? Is there someone available to lend a second ear or to answer questions?
  2. Is the QA person able to provide comment? In other words – can the QA person say, “yes, sending this job to QA was indeed reasonable” so that the MT can be paid the full line rate for those jobs?
  3. Has the company provided sufficient training to the MTs? Does it provide supplemental training for ESL authors or unfamiliar specialties or work types?
  4. Does the company provide reference materials, samples for specific, difficult doctors, and other tools to help MTs?
  5. Does the MT receive feedback on the documents she sends to QA? Does she receive corrected copies?
  6. Is work assigned to MTs such that they are able to become familiar with difficult doctors and unfamiliar specialties?
  7. Are particularly difficult doctors exempted from the threshold?
  8. How is the QA threshold selected? Is it one arbitrary percentage across the company? Are less experienced MTs expected to meet the same threshold as experienced MTs? Is there a higher threshold for known difficult authors or more difficult specialties or work types? Are all MTs held to the same threshold regardless of the level of difficulty of the work?
  9. Is sufficient QA performed on final documents to ensure that quality isn’t suffering as a result of this practice?
  10. Are MTs rewarded financially for consistently high quality work?

My hope is that a company that penalizes MTs for sending work to QA provides the tools and support to MTs to help them to create a high-quality document.  I also hope that if MTs are punished for sending work to QA, that they are also rewarded for producing consistently high quality documents.

My fear is that companies expect to push productivity and decrease QA without taking the measures required to ensure quality… I hope my fears are not justified!

All my best as always,



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